{
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"EIN": null,
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"Credential": "M.DIV.",
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"FirstLineMailingAddress": "111 SILVER BROOK RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILTON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02186-5239",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "617-594-0641",
"MailingAddressFaxNumber": "617-696-8849",
"FirstLinePracticeLocationAddress": "1534 TREMONT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROXBURY CROSSING",
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"PracticeLocationAddressTelephoneNumber": "617-306-6812",
"PracticeLocationAddressFaxNumber": "617-718-2724",
"EnumerationDate": "03/29/2010",
"LastUpdateDate": "03/29/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}